The COVID pandemic did much to upend global health. Not only were hospitals filled to overcapacity worldwide with patients experiencing severe COVID symptoms, but entire health systems were also brought to a halt. Routine medical procedures and quality care in other areas besides COVID were preempted by the global virus. This has caused global health goals to suffer, notably decreasing preventable maternal deaths.
This month the World Health Organization along with the UNFPA created new goals in order to get back on track to reach Sustainable Development Goal 3.1 – reducing the global maternal mortality ratio to less than 70 per 100 000 live births – by 2030. Right now, the estimates are at 211 deaths per 100,000 live births.
Currently, 810 women still die per day due to complications caused by pregnancy and childbirth. While this number is a drastic improvement from a decade ago there is still much to do in order to save more mothers’ lives not only in the United States but worldwide.
You have probably heard the story of Tashonna Ward, the 25-year-old Milwaukee woman who recently spent hours in the emergency room due to shortness of breath and died after waiting too long. Ward was told that she would spend between two to six hours in wait time at the ER according to distressing posts on her Facebook page. Preliminary tests were performed on Ward and showed she had cardiomegaly, an enlarged heart, but she was never admitted despite having chest pains and tightness of breath.
After waiting 2 hours and 29 minutes in the ER, Tashonna Ward and her sister decided to go to urgent care. She never made it. She passed out en route and collapsed and died in the urgent care parking lot. The cause of death: hypertensive cardiovascular disease.
While many reports mentioned the emergency room wait times that led to Ward’s death, a few have reported that she developed cardiomegaly due to pregnancy complications from a miscarriage in March of 2019. In fact, the Milwaukee County Medical Examiner’s Report states that the “decedent did develop cardiomegaly during pregnancy.”
One of the leading causes of maternal mortality in the United States is hemorrhaging. In fact, according to the CDC hemorrhaging accounts for 11.2% of pregnancy-related deaths. Based on these increasing numbers since 1986 the Joint Commission, the country’s leading accreditation organization for hospitals, has created 13 new standards for perinatal safety for hospitals to properly care for women who hemorrhage during or after delivery. These standards were designed specifically to prevent, recognize and treat, as well as evaluate patients for transfer to critical care for not only hemorrhage but also severe hypertension/preeclampsia.
Maternal mortality continues to be a major problem the world over. The United States is the only developed country where maternal death rates are increasing especially for non-Hispanic black women. And in low-and-middle income countries, approximately 830 women die each day from pregnancy-related, preventable causes.
Maternal health organizations are working diligently to save more mothers’ lives, but one death is still too many especially when it is likely preventable. I like to list organizations that you can support with donations in order to help them keep more women and their children alive on the local level and make sure mothers are a part of their families’ lives.
This list highlights local organizations that help some of the most vulnerable communities in countries with some of the highest maternal mortality rates. And, in the cases of the United States and Australia, the organizations help the communities that experience the most maternal deaths. Each site allows direct donations that go directly to maternal care and/or advocacy.
The relatively large number of American women who die due to childbirth is one of the little-known facts in our country. In a nation where we spend exorbitant amounts on healthcare, we have the highest maternal mortality rate of any other developed country. Word, however, is getting out that women are increasingly susceptible of dying during childbirth with a surge in articles in major publications and of hospitals, healthcare workers, and researchers working together to solve this problem.
After eight years of practicing obstetrics and researching childbirth in the United States, I know as well as anyone that the American maternal health system could be better. Our way of childbirth is the costliest in the world. Our health outcomes, from mortality rates to birth weights, are far, far from the best.
The reasons we fall short are not obvious. In medicine, providing more care is often mistaken for providing better care. In childbirth the relationship between more and better is complicated. Texan obstetricians, when compared to their counterparts in neighboring New Mexico, are 50% more likely to intervene on the baby’s behalf by performing a cesarean section. Nonetheless, Texas babies still have a lower survival rate than New Mexican babies.
I long assumed that our most puzzling American health care failures were idiosyncrasies–unique consequences of American culture, geography, and politics. But a trip to India for the 2017 Human Rights in Childbirth meeting led me to a humbling realization: when it comes to childbirth, both countries fall short in surprisingly similar ways.
Human rights in childbirth
I take care of patients in at a well-funded teaching hospital in Boston, where pregnant women seem well-respected and have clear, inviolable rights.
More than likely you have heard about the Global Gag Rule also known as the Mexico City Policy this week. You can learn more about it in a previous post: Why the Global Gag Rule Will Increase Maternal Mortality. To get right to the point, however, Planned Parenthood released this video: What is the Global Gag Rule that explains it succinctly. Continue reading Video: The Global Gag Rule Explained
Throughout my visits to clinics in Africa I have seen the work of Marie Stopes International in South Africa, Tanzania, Ethiopia as well as Zambia. They provide a full range of quality reproductive health services for women. I have always been impressed by the comprehensive care they provide. Now, their work will be hampered because of an imposed policy of the new administration.
Yesterday morning President Trump signed an executive order to reinstate the Global Gag Rule, or Mexico City Policy, that prevents international NGOs that accept USAID (taxpayer) money from advocating for the legalization of abortions, provide abortions, mention the word, or even refer women to health practionioners that provide safe, legal abortions.
The Global Gag Rule was instated during the Reagan admininstration in 1984 and since then there has been a virtual seesaw effect between Republican and Democratic administrations regarding whether the Rule is reinstated or revoked. According to the WHO, 78,000 women die every year from unsafe abortions. Under Obama’s eight year administration, that number was reportedly decreased by more than half. Now, that President Trump has signed this executive order reinstating the Global Gag Rule, the fear among the global health community is that that number will rapidly skyrocket again.
Texas has the highest rate of maternal mortality in the developed world. (Source) In Texas, cardiac events, overdose by licit or illicit prescription drugs, and hypertensive disorders are the leading causes of maternal death. (Source) White women had the highest rates of diagnosed mental illness of any kind (depression as well as other psychological illnesses) in Texas during pregnancy and the puerperium; Black women had … Continue reading 9 Facts We Learned in 2016 About Maternal Mortality in the United States
For years researchers who study maternal morbidity and mortality have been stumped as to why rates continue to rise and why women of color are adversely affected despite education, health care, and socio-economic factors.
A new report and the first of its kind released in May, New York City 2008 – 2012: Severe Maternal Morbidity, shows the myriad reasons why women of color, especially low-income, Black non-Latina, women fare the worse with severe maternal morbidity (SMM). While most studies in the past across the country focus on maternal mortality, this report focused on maternal morbidity, the causes of maternal mortality.